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I have chronic high blood pressure. How does it affect my birth options?
Your birth options will depend on how well managed your blood pressure is, and how you and your baby are doing as your pregnancy progresses. Women with chronic high blood pressure typically deliver at 38 to 39 weeks of pregnancy, as long as blood pressure is well controlled.
But if your healthcare provider is concerned about your or your baby's health, she may decide that it's safer for you to deliver early. Research suggests that about one-quarter of all women with chronic high blood pressure have a preterm birth, which means that their baby is born before 37 weeks. The risk is higher for women with severe high blood pressure (160/110 mmHg or higher): Approximately two-thirds of women with severe high blood pressure have a preterm birth.
Your provider will monitor your baby's growth closely because sometimes high blood pressure makes a baby develop more slowly and be much smaller than normal. This serious condition is called intrauterine growth restriction (IUGR) and puts the baby at risk of many health problems, including stillbirth.
Your provider will carefully balance your health and your baby's needs. Although your provider will want to give your baby as much time to mature as possible, it may be necessary for you to give birth early to protect your own health.
For example, when blood pressure becomes uncontrollable, or if there are signs of organ damage, a baby may need to be born right away. Similarly, if a provider is concerned that a baby isn't growing well, it may be safer for the baby to be premature.
If this happens, you may be referred to a maternal-fetal medicine specialist, who can advise you on treatment and care. If you're less than 34 weeks pregnant, your provider will likely transfer you to a hospital with specialist intensive care for you and your baby.
What's superimposed preeclampsia?
Preeclampsia that develops when you already have high blood pressure is called "superimposed preeclampsia." This extremely rare condition sometimes affects women with chronic high blood pressure.
This type of preeclampsia starts before 20 weeks of pregnancy, making it more dangerous than the other type of preeclampsia, which happens later. Superimposed preeclampsia can get worse quickly and become life-threatening. If you develop superimposed preeclampsia, you'll need to be monitored at a hospital.
Can I have a vaginal birth?
It's possible to have a vaginal birth if you have high blood pressure, even if you develop superimposed preeclampsia. But it's very likely that your labor will be induced.
It's also likely that you'll need to deliver by cesarean section (c-section). About 4 out of 10 women with chronic high blood pressure have a c-section. (Three out of 10 deliveries in the United States are c-sections.)
Whichever way you give birth, your baby's heart rate will be closely monitored throughout to make sure she's coping well with labor. Your heart rate and blood pressure will also be carefully tracked.
You'll be given extra medication if your blood pressure gets too high. This can be administered orally or directly into a vein through a tube in your arm (intravenously).
If you have superimposed preeclampsia, you'll be given magnesium sulphate to prevent seizures (eclampsia) during labor and for 24 hours after delivery.
What happens after I give birth?
Your provider will monitor your blood pressure closely. Your blood pressure may go up in the weeks after you've given birth, so your medication may need to be adjusted. If you stopped taking medication during pregnancy, you may need to start taking it again now.
Tell your provider if you're breastfeeding: Blood pressure drugs can pass into breast milk, and some may cause side effects in a baby.
Although rare, a stroke associated with high blood pressure is more likely to occur after birth than during pregnancy. A stroke is a life-threatening emergency in which blood flow to an area of the brain is cut off, and cells die because they don't get oxygen.
Also, it's possible to develop preeclampsia for the first time after your baby is born. Contact your provider immediately if you develop:
- Severe headache
- Sudden swelling in your face or hands
- Spots in your vision
- Pain in your upper abdomen
- Sudden weight gain
- Difficulty breathing
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.